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A� V® CERTIFICATE OF LIABILITY INSURANCE 0AM 0512012017m THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certi lcate holder Is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER DARRYL NINO INSURANCE AGENCY 4378 EILEEN ST SIMI VALLEY, CA 93063 Q ACT NAME: DARRYL NINO AGENT FNONE 8058 38373 NC No:faDS1823-8377 ADDRESS: dar l.nlnd.rebl statefann.com INSURERS AFFORDING COVERAGE NAIC6 INSURER A: State Fann General Insurance Company Sib INSURED VENTURA BUSINESS SYSTEMS INC C/O TREVOR YATES 2582 FIG ST SIMI VALLEY CA 93063-2416 INSURER 2: State Form Mutual Automobile Insurance Company 25170 INSURERC: INSURERD: INSURER IS: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 1LTR TYPE OF INSURANCE tN U POLICY NUMBER POLICY MMIDDO EXP LRMrs A GENERALDABUM X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ❑X OCCUR 92-W4-0493-7 04/2812017 0_412612018 EACHOCCURRENCE E 1.000,000 PREMISES IEs occurrence E MEO EXP(Any one person) E 5,000 PERSONAL& AOV INJURY S 1.000,00o GENERALAGGREGATE E 2,DC0,000 GENLAGGREOATE X POLICY[71 LIMIT APPLIES PER: PER LOC PRODUCTS-COMP/OPAGG E 2.000.000 E B AUTOMOBR.ELIABILITY X ANY AUTO AOEO AUTOS AUTOS HIRED AUTOS AUT09 ED ❑ 0515512-A18-75L 051 6512-A18-75L 01/1812017 07/18/2017 07/1812017 01/1812018 Ee eulJdEentsl GLE LIMN E BODILY INJURY ((Perpenon) E 1,000.000 BODILY INJURY(Peraccidenl) BODILY E 1,000,000 PerraceldenIDAMAGE S 1,000,Co0 E UMBRELLA LIAB EXCESS OAS OCCUR CLAIMS -MADE Pl EACH OCCURRENCE E AGGREGATE E DED I I RETENTICNS E WORKERS COMPENSATION ANO EMPLOYERS LIABILnY ANYPROPRIETORIPARTNEP/EXCCUTNE YIN OFFlCFJMEMBER EXCLUDED? ❑ (NmdatMInNH) I(yaa, desull,e under NIA ❑ �e� 0 �1a G�QI V �'�•' YIC STATU- OTH- EL EACH ACCIDENT E E.L. DISEASE -EA EMPLG E E.L. DISEASE• POLICY LIMIT 1 E s AON,4t 5P DESCRIPTION OF OPERATIONS/ LOCATIONS I VEHICLES (A ch ACORD1C1,Addldonal Remarks Schedule,amomspacelemquirod) There is no Workers Compensation policy for Ventura Business Systems as all employees are officers of the corporation. Officers of the Corporation are net required to have a Work Comp policy in the Slate of California. ADDITIONAL INSURED: CITY OF SANTA ANA, ITS OFFICERS, AGENTS, AND EMPLOYEES 20 CIVIC CENTER PLAZA. SANTA ANA, CA 92701 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. J ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD 1001486 132849.6 11-15.2010